1. Field of the Invention
The present invention relates generally to surgical devices and methods for closing relatively large incisions, such as abdominal laparotomies.
2. Background Discussion
A laparotomy is a surgical incision in the abdominal cavity typically performed for the purpose of surgical treatment of abdominal organs, examination of abdominal organs, and/or to aid in diagnosis of any problems such as abdominal pain. The most typical type of incision is a midline, or vertical incision, that may be four to ten inches in length. Following the procedure, the incision must be closed, with the most common form of closure being with surgical sutures. Because of the length and depth of the incision, however, and the muscular nature of the abdominal area, the surgical sutures can experience significant tension during the recovery period of wound healing. This is particularly true when there is excessive swelling, or edema, or inflammation; in obese patients; or during normal expansion of the abdominal wall as can occur during breathing, coughing, bowel movements, heavy lifting etc. When under tension, the incisional repair can be compromised or even fail, due to the “sawing” effect of the sutures on the tissue. The situation is exacerbated in patients with multiple co-morbidities and compromised tissue integrity, such as in patient's having diabetes, cancer, immunodeficiency, older patients etc. The result of failure or partial failure often is an incisional hernia, where tissues or organs of the abdomen, mostly fatty tissue from the omentum or bowel, protrude through the hernia defect. The hernia appears as a bulge under the skin, and can be painful or tender to the touch. In case of strangulation or incarceration of hernia contents, this might even lead to life threatening situations that require emergency surgery.
In some instances, surgical meshes have been used in the conventional manner to lower the rate of incisional hernias. Meshes used in the conventional manner, however, leave behind a substantial amount of foreign body material in the patient, which has its own drawbacks such as increased risk of infection, chronic pain or discomfort. Further, a large amount of tissue dissection is required to place such meshes, the trauma of which leads to increased tissue inflammation. Finally, the extensive tissue dissection also requires a significant amount of time to properly place the mesh.
Accordingly, what is needed is an improved device and method for closure of large incisions such as abdominal laparotomies.